Nutrition and Growth in Children with Chronic Liver Disease and After Liver Transplantation

Abstract:

Malnutrition is a common complication of chronic liver disease (CLD). Standard anthropometric techniques available to assess nutritional status in children with CLD are noted to be inadequate but more sophisticated methods are all limited to research. Nutritional interventions in a few case studies have shown to improve the outcome of children after liver transplantation, but there remains a lack of systematic studies on this subject. What has been established is the relationship between poor nutritional status and growth failure, which sometimes continues following transplantation. The mechanisms underlying growth failure relate to disturbances in the GH/IGF axis and the effects of immunosuppression after liver transplantation. Current methods of trying to improve nutritional status prior to transplantation include intensive nasogastric feeding and in extreme cases parenteral nutrition. These are based on recommendations made in the late 1980s and early 1990s. Since this time there have been no advances in nutritional therapy for children with CLD. While review articles on the subject repeatedly call for more investigations into the use of growth hormone, zinc, and other novel substrates; research into nutritional support in these subjects lays dormant. While transplantation may offer a way of reversing the signs of poor nutritional status, growth failure continues to be a problem, which is a distressing consequence for affected children.

Abstract: Malnutrition is a common complication of chronic liver disease (CLD). Standard anthropometric techniques available to assess nutritional status in children with CLD are noted to be inadequate but more sophisticated methods are all limited to research. Nutritional interventions in a few case studies have shown to improve the outcome of children after liver transplantation, but there remains a lack of systematic studies on this subject. What has been established is the relationship between poor nutritional status and growth failure, which sometimes continues following transplantation. The mechanisms underlying growth failure relate to disturbances in the GH/IGF axis and the effects of immunosuppression after liver transplantation. Current methods of trying to improve nutritional status prior to transplantation include intensive nasogastric feeding and in extreme cases parenteral nutrition. These are based on recommendations made in the late 1980s and early 1990s. Since this time there have been no advances in nutritional therapy for children with CLD. While review articles on the subject repeatedly call for more investigations into the use of growth hormone, zinc, and other novel substrates; research into nutritional support in these subjects lays dormant. While transplantation may offer a way of reversing the signs of poor nutritional status, growth failure continues to be a problem, which is a distressing consequence for affected children.